Clinical Practice in Urology Series Editor: Geoffrey D. Chisholm

Titles in the series already published

Urinary Diversion Edited by Michael Handley Ashken

The Pharmacology of the Urinary Tract Edited by M. Caine

Bladder Cancer Edited by E.J. Zingg and D.M.A. Wallace

Percutaneous and Interventional Urology and Radiology Edited by Erich K. Lang

Adenocarcinoma of the Prostate Edited by Andrew W. Bruce and John Trachtenberg

Controversies and Innovations in Urological Surgery Edited by Clive Gingell and Paul Abrams

Combination Therapy in Urological Malignancy Edited by Philip H. Smith

Current Perspectives in Paediatric Urology Edited by Robert H. Whitaker

Practical Urology in Spinal Cord Injury Edited by Keith F. Parsons and John M. Fitzpatrick

Forthcoming titles in the series

Male Infertility (Second Edition) Edited by T.B. Hargreave

Urodynamics (Second Edition) Paul Abrams, Roger Feneley and Michael Torrens

Urological Prostheses, Appliances and Catheters

Edited by

John P. Pryor

With 111 Figures

Springer-Verlag London Berlin Heidelberg New York Paris Tokyo Hong Kong Barcelona Budapest

John P. Pryor, MS, FRCS Consultant Urologist, King's College and St. Peter's Hospitals, London, UK

Series Editor

Geoffrey D. Chisholm, ChM, FRCS, FRCSEd Professor of Surgery, University of Edinburgh; and Consultant Urological Surgeon, Western General Hospital, Edinburgh, Scotland

Cover illustration: Ch. 3, Fig. 8b. From Mardis HK et al. (1979) Double pigtail uretal stent. Urology 14:23-26.

ISBN-13:978-1-4471-1463-S e-ISBN-13:978-1-4471-1461-1 DOl: 10.1007/978-1-4471-1461-1

British Library Cataloguing in Publication Data Pryor, J. P. (John P)

Urological prostheses, appliances and catheters.­(Clinical practice in urology) I. Title II. Series 616.6

ISBN-13:978-1-4471-1463-5

Library of Congress Cataloging-in-Publication Data Urological prostheses, appliances, and catheters / edited by John P.

Pryor. p. cm. - (Clinical practice in urology)

Includes index. ISBN-13:978-1-4471-1463-5

1. Urological prostheses. I. Pryor, J. P. (John P.) II. Series. [DNLM: 1. Prosthesis. 2. Urogenital Diseases-surgery.

3. Urology-instrumentation. WJ 168 U78] RD571. U756 1991 617.4'60592-dc20 DNLMIDLC

for Library of Congress 91-5158

CIP

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of repro graphic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.

© Springer-Verlag London Limited 1992 Softcover reprint of the hardcover 1st edition 1992

The use of registered names, trademarks etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use.

Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature.

Typeset by Best-set T~pesetter Ltd., Hong Kong 28/3830-543210 Printed on acid-free paper

Series Editor's Foreword

The title of this book gives a clear indication of the changes in emphasis that are occurring in urology. Is it possible that prostheses, appliances and catheters represent such a significant part of urology that they require a book devoted to them? The answer is most certainly "yes", mainly because there are now so many aspects to this theme and yet it is difficult to find a ready reference source.

Urology has always been a subject that dealt with "plumbing and tubes": historically this was a major part of urology. Now many urological problems can be treated by a range of procedures many of which require the implantation of manufactured devices. The range of materials currently available for these devices has led to further developments in the prostheses and appliances available for urological care.

Until now the knowledge on these topics has been covert: articles here and there, lectures mentioning some developments, commercial companies pressing their new products on the profession, etc. Hard facts on the merits of these developments were difficult to obtain. Often, just when a device is becoming accepted and experience gained, along comes another modification. The facts can only be obtained from the experience of those with special interests in these matters. I have been and remain a strong supporter of the controlled clinical trial, but the evaluation of surgical procedures and prostheses is not easily applicable to this discipline. We must therefore rely on the accumulated experience of acknowledged experts. This book brings together such expertise in a variety of situations that are constant problems for the urologist. The aim of this Series is to bring to the reader the best possible opinions in the clinical practice of urology. Mr. Pryor and his well-selected colleagues have easily achieved this aIm.

Edinburgh November 1991

Geoffrey D. Chisholm

Preface

This volume is intended to collect together those aspects of urology which depend upon manufactured articles that are inserted in or attached to patients. They are of relevance to every urologist and range from the mundane to the highly specialised.

Urological practice has changed a great deal during the past decade or so and this is reflected in the current volume. In some areas, the innovations are rapidly succeeded by newer techniques and fade to oblivion. The increased pace of change is the result of manufacturers and urologists working together to take advantage of the new technologies and materials that have been developed. Some manufacturers have a major commitment to genitourinary surgery and this financial investment is to the benefit of our patients. Such is the speed of change that it is impossible to be up-to-date in all areas. Nevertheless, it is to be hoped that the current volume provides a sound basis for clinical urologists.

The original concept was to divide the book into the different aspects of the title but on reflection it seemed better to group the chapters on a more functional and anatomical basis.

Institute of Urology, London February 1991

John P. Pryor

Contents

List of Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Editorial: Synthetic Soft Tissue Substitutes J. P. Pryor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Xlli

Chapter 1 Open Nephrostomy J. W.A. Ramsay ......................................... 1

Chapter 2 Percutaneous Nephrostomy R.A. Miller. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Chapter 3 Ureteric Stents R.P. Finney and S.c. Hopkins

Chapter 4 Urethral and Suprapubic Catheters

33

M. C. Bishop and R.J. Lemberger. . . . . . . . . . . . . . . . . . . . . . . . .. 73

Chapter 5 Implantable Incontinence Devices P.H.L. Worth ........................................... 109

Chapter 6 Urinary Incontinence Appliances, Aids and Equipment R. N. P. Carroll . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 133

Chapter 7 Prosthetic Urethral Substitution P.J.R. Shaw . ........................................... 167

x Contents

Chapter 8 Urostomy Appliances R.N.P. Carroll . ......................................... 175

Chapter 9 Penile Prostheses I.P. Pryor . ............................................. 197

Chapter 10 Vas Deferens Prostheses S. S. Schmidt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 229

Chapter 11 Alloplastic Spermatocele (Sperm Reservoirs) A. Kelfimi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 239

Chapter 12 Testicular Prostheses I.P. Pryor . ............................................. 247

Chapter 13 Vascular Access C.I. Rudge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 257

Chapter 14 Antibiotic Therapy W.R. Gransden and P.M. Thompson ....................... 269

Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 283

Contributors

M.C. Bishop, MD, MRCP, FRCS Consultant Urological Surgeon, City Hospital, Nottingham, UK

RN.P. Carroll, MB, BCh, BAO, BSc, FRCS, FRCS(Ed) Consultant Urologist, Manchester Royal Infirmary and St. Mary's Hospital, Manchester, UK

RP. Finney, MD, FACS Professor of Surgery, Division of Urology, University of South Florida Medical College and James A Haley Veterans Hospital, Tampa, Florida, USA

W.R Gransden, MRCPath Senior Lecturer, Department of Medical Microbiology, United Medical and Dental School of Guy's, St. Peter's and St. Thomas's Hospitals, London, UK

S.C. Hopkins, MD, FRCS(C) Assistant Professor of Surgery, Division of Urology, University of South Florida Medical College and James A Haley Veterans Hospital, Tampa, Florida, USA

A. Kelami, MD Consultant Urologist, Brahmstrasse 32, D-lOOO Berlin 45, Germany

R.J. Lemberger, FRCS Consultant Urological Surgeon, Mansfield Hospitals and City Hospital, Nottingham, UK

R.A. Miller, MS, MB, FRCS Consultant Urologist, Whittington Hospital, London, UK

J.P. Pryor, MS, FRCS Consultant Urologist, King's College and St. Peter's Hospitals, London, UK

xii Contributors

J.W.A. Ramsay, MS, FRCS Consultant Urologist, Charing Cross and West Middlesex Hospitals, London, UK

c.J. Rudge, FRCS Consultant Transplant Surgeon, St. Peter's Hospitals, London, UK

S.S. Schmidt, MD Consultant Urologist, Department of Urology, University of California School of Medicine, San Francisco, California, USA

P.J.R. Shaw, FRCS Senior Lecturer and Honorary Consultant Urologist, St. Peter's Hospitals, London, UK

P.M. Thompson, FRCS Consultant Urologist, Joyce Green Hospital, Dartford, Kent, UK

P.H.L. Worth, FRCS Consultant Urologist, St. Peter's Hospitals, London, UK

Editorial: Synthetic Soft Tissue Substitutes

Materials must feature in any book about prostheses, appliances and catheters and this introduction attempts to summarise some of the basic considerations that are relevant to clinicians and common to all prostheses.

In 1953 Professor John Scales of the Institute of Orthopaedics, London, listed the ideal characteristics of synthetic soft tissue sub­stitutes. These are worth repeating as they remain relevant today. He stated that they should:

1. not be physically modified by body fluids 2. be chemically inert 3. not incite inflammatory or foreign body cell response in the

tissues 4. not be carcinogenic 5. not produce a state of allergy or hypersensitivity 6. resist mechanical strains 7. be capable of manufacture in the desired form 8. be capable of being sterilised

In addition, synthetics should also be cheap to manufacture. An additional quality that is necessary for catheters is that they should not be subject to encrustation.

Rubin et al. (1971) reviewed a 20-year experience with synthetic plastics and found that polyethylene was suitable for use in the head and neck region. Beheri (1966) reported the implantation of paired polyethylene prostheses into the penis in 600 men, but the mechanical qualities of the prosthesis were unsatisfactory. It was not until medical grade silicones were developed that a suitable material was found for the manufacture of flexible soft tissue prosthetic use. Frisch (1983) reviewed the technology of silicones and these form the basis of most urological prostheses and of many catheters.

Silicones are not entirely inert and Habal (1984) reviewed the clinical aspects of their use. Silicone particles may enter the blood­stream to cause granulomatous hepatitis or pancytopenia (Ellenbogen

xiv Editorial: Synthetic Soft Tissue Substitutes

et al. 1975; Bommer and Ritz 1981) or lymphadenopathy (Travis et al. 1985). Such findings have not been observed after urological procedures.

The occurrence of neoplasia after the insertion of silicone has been described (Digby and Wells 1981) but is usually related to the development of breast cancer (Bowers and Radlauer 1969; de Cholnoky 1970; Johnson and Lloyd 1974; Zafiracopoulos and Rouskas 1974; Dalal et al. 1980). Such a relationship may be no more than happenstance.

Silicone prostheses are not rejected by the body and the major problem is the prevention of infection and it is for this reason that the topic merits a separate chapter. The pathobiology of infection in prosthetic devices was reviewed by Dougherty (1988) and all authors advocate the use of prophylactic antibiotics. The impregna­tion of a prosthesis with antibiotics (Olanoff et al. 1979) or anti­septics (Habal 1984) has not entered urological practice although the soaking of the prosthesis in antibiotics at the time of implanta­tion is not uncommon.

It is interesting to read the chapter headings in an earlier book entitled Genitourinary Reconstruction and Prostheses (Wagenknecht et al.) which was published in 1981. This book contained the results of much experimental work and background information about the early development of ureteric stents and incontinence and penile prostheses. However ureteric, bladder and urethral prosthetic replacement remains experimental and has not passed into clinical usage. It is impossible to include everything and omissions occur not only as a result of developing practice but due to an overlap in practice. The use of transluminal balloon catheters is a good example of this. Some of these aspects are discussed in Percutaneous and Interventional Urology (Lang 1986). Balloon dilatation of the renal artery (Zeitler 1986) or occlusion of the testicular veins (Barth 1986) were included, as was balloon dilatation of ureteric strictures (Bigongiari 1986). Balloon dilatation for the prostate has received more recent interest (Burhenne et al. 1984; Gill et al. 1989; Dowd and Smith 1990) as have other non-operative techniques for treat­ment of benign prostatic obstruction.

The technological revolution has just begun to impinge upon urology and our clinical practice is likely to change even more in the next decade.

References

Barth KH (1986) Balloon embolization for the treatment of primary varicocele. In: Lang EK (ed) Percutaneous and interventional urology and radiology. Springer Verlag, Berlin, pp 211-216

Beheri GE (1966) Surgical treatment of impotence. J Plast Reconstr Surg 38:92-97 Bigongiari LR (1986) Transluminal dilatation of ureteric strictures. In: Lang EK (ed)

Percutaneous and interventional urology and radiology. Springer Verlag, Berlin, pp 113-118

Editorial: Synthetic Soft Tissue Substitutes xv

Bommer J, Ritz E (1981) Safety and silicone. Lancet 2:419 Bowers DG, Radlauer CB (1969) Breast cancer after prophylactic subcutaneous

mastectomies and reconstruction with silastic prostheses. Plast Reconstr Surg 4: 541-544

Burhenne HJ, Chisolm RJ, Quenville NF (1984) Prostatic hyperplasia: radiologic intervention. Radiology 152:655-657

Dalal JJ, Winterbottam T, West RR, Henderson AH (1980) Implanted pacemakers and breast cancer. Lancet 2:311

de Cholnoky T (1970) Augmentation mammoplasty; survey of complications in 10,941 patients by 265 surgeons. Plast Reconstr Surg 45:573-577

Digby JM, Wells AL (1981) Malignant lymphoma with intranodal refractile particles after insertion of silicone prostheses. Lancet 2:580

Dougherty SH (1988) Pathobiology of infection in prosthetic devices. Rev Infect Dis 10:1102-1117

Dowd JB, Smith JJ (1990) Balloon dilatation of the prostate. Urol Clin North Am 15:671-677

Ellenbogen R, Ellenbogen R, Rubin L (1975) Injectable fluid silicone: human morbidity and mortality. JAMA 234:308-309

Frisch EE (1983) Technology of silicones in biomedical applications. In: Rubin L (ed) Biomaterials in reconstructive surgery. CV Mosby, St Louis, pp 73-91

Gill KP, Machan S, Allison DJ, Williams G (1989) Bladder outflow tract obstruction and urinary retention from benign prostatic hypertrophy treated by balloon dilata­tion. Br J Urol 64:618-622

Habal MG (1984) The biologic basis for the clinical application of the silicones. Arch Surg 119:843-848

Johnson M, Lloyd HED (1974) Bilateral breast cancer 10 years after an augmenta­tion mammoplasty. Plast Reconstr Surg 53:88-90

Lang EK (ed) (1986) Percutaneous and interventional urology and radiology. Springer Verlag, Berlin

OIanoff LS, Anderson JM, Jones RD (1979) Sustained release of gentamicin from prosthetic heart valves. Trans Am Artif Intern Organs 25:334-338

Rubin LR, Bromberg BE, Walden RH (1971) Long term human reaction to synthetic plastics. Surg Gynec Obstet 132:603-608

Scales JT (1953) Tissue reactions to synthetic materials. Proc R Soc Med 46:647-652 Travis WD, Balogh K, Abraham JC (1985) Silicone granulomas. Hum Pathol 16:

19-27 Wagenknecht LV, Furlow WL, Auvert J (1981) Genitourinary reconstruction with

prostheses. George Thieme Verlag, Stuttgart Zafiracopoulos P, Rouskas A (1974) Breast cancer at site of implantation of pace­

maker generator. Lancet 1:1114 Zeitler E (1986) Technique and results of percutaneous renal artery dilatation. In:

Lang EK (ed) Percutaneous and interventional urology and radiology. Springer Verlag, Berlin, pp 233-249